Postoperative Oral Dexamethasone and Pediatric Tonsillectomy Morbidity: A Randomized Clinical Trial.

Randomized trialJAMA otolaryngology-- head & neck surgery· Jul 2026

Postoperative Oral Dexamethasone and Pediatric Tonsillectomy Morbidity: A Randomized Clinical Trial.

Amber D Shaffer, Mahmoud Omar, Raymond C Maguire … David H Chi

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Pediatric ENTRandomized trialTreatmentQ1IF 3.4

Postoperative oral dexamethasone lowered odds of receiving an opioid prescription after tonsillectomy.

Postoperative Oral Dexamethasone and Pediatric Tonsillectomy Morbidity: A Randomized Clinical Trial.

Amber D Shaffer … David H Chi

JAMA otolaryngology-- head & neck surgery · Jul 2026 · Q1 in Otorhinolaryngology

Background

IMPORTANCE: Tonsillectomy is among the most painful otolaryngologic procedures.

Purpose

To determine whether a postoperative course of oral dexamethasone reduces postadenotonsillectomy pain in children.

Methods

Oral dexamethasone (0.5 mg/kg; maximum dose, 20 mg) or placebo on postoperative days 2, 4, and 6.

n = 763 children

Results

dexamethasone sharply cut the odds of needing an opioid prescription

OR 0.23 (95% CI 0.06 to 0.84)

null 1

0.06

0.84

CI excludes the null - significant

More results

Mean (SD) pain before acetaminophen or ibuprofen on days 2 to 8 was 0.72 (95% CI, 0-1.44) points lower in the dexamethasone group (4.12 [2.00]) than placebo (4.84 [2.15]), but wide 95% CIs and differences in pain prior to taking the study medication prevented making definitive conclusions.

However, the precision of these estimates limits interpretability.

“

Conclusion

In this randomized clinical trial, postoperative oral dexamethasone was associated with a modest reduction in pain after pediatric adenotonsillectomy, a considerable reduction in opioid prescriptions, and no increase in complications, supporting its use as an analgesic adjunct.

Postoperative Oral Dexamethasone and Pediatric Tonsillectomy Morbidity: A Randomized Clinical Trial.

Postoperative Oral Dexamethasone and Pediatric Tonsillectomy Morbidity: A Randomized Clinical Trial.

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